The levator palpebrae superioris (LPS) muscle is the main retractor of the upper eyelid, responsible for elevating the upper eyelid and maintaining it in an open position. Sound knowledge of its anatomy and adjacent structures is essential for eyelid surgery. Work from researchers and anatomists over the years continue to enrich our understanding in the anatomy of the LPS. In this review, we present an update on the anatomy of the LPS and its surgical implications. Important adnexa such as Whitnall's ligament, intermuscular-transverse ligament and Müller's muscle are also covered.
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Aim: To report the outcome of treatment of localised non-invasive ocular surface squamous neoplasia (OSSN) where topical 5-fluorouracil (5-FU 1%) is used as an adjuvant to surgical excision. Methods: The study was a prospective non-comparative interventional case series. 55 cases of primary localised OSSN and 10 cases of recurrent localised OSSN were treated with excision, cryotherapy and adjuvant 5-FU 1%. In all cases, irrespective of the involvement of surgical margins, a single cycle of 5-FU 1% was administered, four times a day for 2 weeks continuously. The main outcome measures were (1) recurrence and (2) complications related to adjuvant topical chemotherapy. Individuals were reviewed for a minimum of 12 months. Results: There was a single case of recurrence (1.5%). 57% of patients had short-term complications secondary to 5-FU 1%, most frequently lid toxicity (49%), followed by superficial keratitis, epiphora and corneal epithelial defects. Four patients were unable to complete the course of 5-FU 1% because of local toxicity. Conclusions: The management of localised non-invasive OSSN with adjuvant 5-FU 1% was associated with a low rate of local recurrence. Although 5-FU 1% frequently results in short-term complications, most commonly lid toxicity, a full course is usually tolerated. Serious complications appear uncommon in the treatment of localised disease.
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Aim: To report the outcome of treatment of non-invasive ocular surface squamous neoplasia (or conjunctival-corneal intra-epithelial neoplasia (CCIN)) where topical mitomycin C (MMC) has been used in the treatment regimen. Design: Prospective, non-comparative interventional case series. Participants: 91 primary or recurrent CCIN lesions from 90 patients treated in a single ocular oncology centre over a 10.5-year period. Intervention: 73 cases of localised, non-invasive CCIN and eight cases of recurrent CCIN received a treatment regimen of surgical excision±cryotherapy, followed by two to three 1-week cycles of adjuvant topical MMC (0.04% four times a day). 10 cases of diffuse CCIN received two to three 1-week cycles of topical MMC (0.04% four times a day) as sole primary treatment. Main outcome measure: Successful treatment was defined as no clinical recurrence of CCIN. Results: Mean follow-up of 56.8 months (range 5.8 to 119.8) and median 57.3 months, revealed no recurrences (0%) in the localised primary group, and one persistent case and two recurrences (30%) in the diffuse primary group. There was one recurrence (12.5%) in the recurrent group, but this was in the only eye with a diffuse type of recurrence. Conclusions: MMC treatment following surgical excision appears to decrease the recurrence rate of localised CCIN and should be considered as adjuvant therapy in primary treatment. MMC should also be considered as adjuvant therapy in the treatment of localised recurrent disease. MMC may be used as sole therapy in more diffuse disease, but close ongoing follow-up is recommended in view of the significant risk of persistent or recurrent disease.
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